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DATE RECEIVED EHO LOG Numem <br /> � SAN J(`^QUIN COUNTYPUBLIC HEALTH SER ICES <br /> �VIRONMENTAL HEALTH DIVISIOi'� <br /> STOCKTON CA 95202 <br /> �0 (209)466 3420 <br /> oma/ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `�'��� /�'/QVC E? BUSINESSIAGENCY �f��n �`� • <br /> ye <br /> APPLICANT <br /> ADDRESS o[�r' v7 TTL° 9-)F"` —5 2 <br /> 001 <br /> PHONE CaQ4) 9y - 13ys FACSIIMILEy,) <br /> o , �/X� ,r <br /> TENTATIVE' APPOINTMENTOATE �,2/�K//d/ TIME J OQ �"�'(Please give 7 to 10 business days from Cate of application=bmihal) <br /> G IU17,_5 a, 3, //- <br /> C1 CHECK BOX TO EXPEDITE REQUEST•$97.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DA _- <br /> SIGNATURE OF APPLICANT J =—v�� DATE !-�' e,-/ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> \1b /s AA cc. G4- - O <br /> Uff <br /> V <br /> 7 �MM <br /> W <br /> ENVIRONMENTAL HEALTH DIVISION FILES' S <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ! SOLID WASTE FACILITY <br /> THER CLEANUP SITE(MON-LOP) El FOOD FACILITY _,t SOLID WASTE VEHICLE <br /> 9]UNDERGROUND TANK(MONnORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TAYTOOIBODY PEIRCING 0 POOLISPA ' ' ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-013S or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant. Future file reviews by the same appllcant may require a$57.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> as W a Qwffib <br />